Comparison of Propofol-Dexmedetomidine-Based Intravenous and Sevoflurane-Based Inhalational Anesthesia in Patients Undergoing Modified Radical Mastectomy

Abstract

Background and aim: Total intravenous anesthesia (TIVA) has proven advantage over inhalational anesthesia in terms of stable hemodynamic, eco-friendly, and good recovery profile, but apprehension regarding adequate depth of anesthesia and intraoperative recall is still pertaining. This study aims to compare propofol-dexmedetomidine-based TIVA with sevoflurane-based inhalational anesthesia in modified radical mastectomy in terms of depth of anesthesia, intraoperative recall, recovery profile, and hemodynamic status.

Settings and design: This prospective randomized controlled study was conducted at a tertiary care center over a time frame of 1 year.

Methodology: In this randomized controlled study, 100 patients were randomly distributed into two groups: TIVA (Group T) and inhalational anesthesia (Group I). Group T patients received injection dexmedetomidine: 1 μg.kg^-1 over 10 min followed by 0.7 μg.kg^-1.h^-1 and injection propofol: 25-100 μg.kg^-1.min^-1. Ventilation was maintained with oxygen-air gas flow. In Group I, patients were ventilated with nitrous oxide-oxygen (50:50) and sevoflurane. Rest of anesthesia for both the groups was same. Primary objective was to achieve adequate depth of anesthesia as monitored by intraoperative bispectral index value (BIS, 40-60). Hemodynamic variables, recovery profile, and amount of individual anesthetic agent consumed were recorded for comparison between two groups. For comparison of scale variables between two groups, independent sample t-test for significant difference between two sample means has been followed.

Results: Intraoperative BIS and hemodynamic variables were comparable (P > 0.05). Emergence time was 5.10 min in the TIVA group versus 8.38 min in the inhalational group (P = 0.00). Modified Aldrete score was comparable in two groups (P > 0.05). Cost of TIVA agents consumed per patient was 40% lesser than inhalational agents.

Conclusion: TIVA maintains adequate depth of anesthesia along with stable hemodynamic and good recovery profile, at low cost in an eco-friendly manner.

Keywords: Air environmental pollutants; greenhouse effect; inhalation anesthesia; intraoperative awareness; intravenous anesthesia; modified radical mastectomy.

Figure 1

CONSORT flow diagram

Figure 2

Bispectral index values at different time intervals between two groups

Figure 3

Heart rate (beats/min) at different time intervals between two groups

Figure 4

Mean arterial pressure (mm of Hg) at different time intervals between two groups